|
sesame seed IgE REF602485
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
SESTAMIBI
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT A9500
|
| Hospital Charge Code |
2410050
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$182.75 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$584.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Humana ChoiceCare |
$190.06
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$438.60
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$643.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$182.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$365.50
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
SESTAMIBI
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT A9500
|
| Hospital Charge Code |
2410050
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$511.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
SEVELAMER CARBONATE 800 MG TAB
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 65862092127
|
| Hospital Charge Code |
3303253
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
SEVELAMER CARBONATE 800 MG TAB
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 65862092127
|
| Hospital Charge Code |
3303253
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
SEVER CRANIAL NERVE
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
CPT 64771
|
| Hospital Charge Code |
6164771
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.88 |
| Max. Negotiated Rate |
$1,161.85 |
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: First Health Workers Compensation |
$472.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$856.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Worker's Compensation |
$333.88
|
|
|
SEVER CRANIAL NERVE
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
CPT 64771
|
| Hospital Charge Code |
6164771
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$333.88 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$733.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cash Price |
$733.80
|
| Rate for Payer: Cigna Commercial |
$1,039.55
|
| Rate for Payer: First Health Commercial |
$1,100.70
|
| Rate for Payer: First Health Workers Compensation |
$472.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,100.70
|
| Rate for Payer: GEHA Commercial |
$978.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,100.70
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,112.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$856.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,100.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,161.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$917.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,137.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$489.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$333.88
|
|
|
sex hormone binding globulin REF82016
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2299564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$39.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$39.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$21.73
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$33.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$121.60
|
| Rate for Payer: GEHA Medicare |
$21.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Humana ChoiceCare |
$23.90
|
| Rate for Payer: Humana Medicare Advantage |
$21.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$36.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$21.73
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.94
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$36.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$21.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$43.46
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$21.30
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$21.73
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Medicare |
$18.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.08
|
| Rate for Payer: Zelis Worker's Compensation |
$23.44
|
|
|
sex hormone binding globulin REF82016
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2299564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: First Health Workers Compensation |
$33.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$136.80
|
| Rate for Payer: GEHA Commercial |
$106.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$136.80
|
| Rate for Payer: Multiplan All |
$138.32
|
| Rate for Payer: OMNI Networks Commercial |
$106.40
|
| Rate for Payer: One Health Plan PPO/POS |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$144.40
|
| Rate for Payer: Three Rivers Provider Network All |
$114.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$141.36
|
| Rate for Payer: Zelis Auto |
$60.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.44
|
|
|
SGPT/ALT (Vitros)
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
2232200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.30
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$88.40
|
| Rate for Payer: First Health Commercial |
$93.60
|
| Rate for Payer: First Health Workers Compensation |
$9.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$93.60
|
| Rate for Payer: GEHA Commercial |
$83.20
|
| Rate for Payer: GEHA Medicare |
$5.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$93.60
|
| Rate for Payer: Humana ChoiceCare |
$5.83
|
| Rate for Payer: Humana Medicare Advantage |
$5.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.30
|
| Rate for Payer: Multiplan All |
$94.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.01
|
| Rate for Payer: OMNI Networks Commercial |
$72.80
|
| Rate for Payer: One Health Plan PPO/POS |
$93.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$98.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.60
|
| Rate for Payer: Three Rivers Provider Network All |
$78.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.19
|
| Rate for Payer: United Healthcare Commercial |
$88.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$96.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.30
|
| Rate for Payer: Zelis Auto |
$41.60
|
| Rate for Payer: Zelis Medicare |
$4.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.36
|
| Rate for Payer: Zelis Worker's Compensation |
$6.77
|
|
|
SGPT/ALT (Vitros)
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
2232200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$88.40
|
| Rate for Payer: First Health Commercial |
$93.60
|
| Rate for Payer: First Health Workers Compensation |
$9.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$93.60
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$93.60
|
| Rate for Payer: Multiplan All |
$94.64
|
| Rate for Payer: OMNI Networks Commercial |
$72.80
|
| Rate for Payer: One Health Plan PPO/POS |
$93.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$98.80
|
| Rate for Payer: Three Rivers Provider Network All |
$78.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$96.72
|
| Rate for Payer: Zelis Auto |
$41.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.77
|
|
|
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER OVER 2.0 CM
|
Facility
|
OP
|
$758.74
|
|
|
Service Code
|
CPT 11303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: First Health Workers Compensation |
$488.25
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$345.23
|
|
|
SHAVING SKIN LESION 1 T/A/L DIAM 0.5CM/<
|
Facility
|
IP
|
$266.82
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
8511300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$253.48 |
| Rate for Payer: Cash Price |
$160.09
|
| Rate for Payer: Cigna Commercial |
$226.80
|
| Rate for Payer: First Health Commercial |
$240.14
|
| Rate for Payer: First Health Workers Compensation |
$103.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.14
|
| Rate for Payer: GEHA Commercial |
$186.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.14
|
| Rate for Payer: Multiplan All |
$242.81
|
| Rate for Payer: OMNI Networks Commercial |
$186.77
|
| Rate for Payer: One Health Plan PPO/POS |
$240.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.48
|
| Rate for Payer: Three Rivers Provider Network All |
$200.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.14
|
| Rate for Payer: Zelis Auto |
$106.73
|
| Rate for Payer: Zelis Worker's Compensation |
$72.84
|
|
|
SHAVING SKIN LESION 1 T/A/L DIAM 0.5CM/<
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
9400001
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$239.70
|
| Rate for Payer: First Health Commercial |
$253.80
|
| Rate for Payer: First Health Workers Compensation |
$108.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.80
|
| Rate for Payer: GEHA Commercial |
$197.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.80
|
| Rate for Payer: Multiplan All |
$256.62
|
| Rate for Payer: OMNI Networks Commercial |
$197.40
|
| Rate for Payer: One Health Plan PPO/POS |
$253.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.90
|
| Rate for Payer: Three Rivers Provider Network All |
$211.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.26
|
| Rate for Payer: Zelis Auto |
$112.80
|
| Rate for Payer: Zelis Worker's Compensation |
$76.99
|
|
|
SHAVING SKIN LESION 1 T/A/L DIAM 0.5CM/<
|
Facility
|
OP
|
$266.82
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
8511300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$160.09
|
| Rate for Payer: Cash Price |
$160.09
|
| Rate for Payer: Cigna Commercial |
$226.80
|
| Rate for Payer: First Health Commercial |
$240.14
|
| Rate for Payer: First Health Workers Compensation |
$103.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.14
|
| Rate for Payer: GEHA Commercial |
$213.46
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.14
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$242.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$186.77
|
| Rate for Payer: One Health Plan PPO/POS |
$240.14
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$200.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$106.73
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$72.84
|
|
|
SHAVING SKIN LESION 1 T/A/L DIAM 0.5CM/<
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
6111300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$239.70
|
| Rate for Payer: First Health Commercial |
$253.80
|
| Rate for Payer: First Health Workers Compensation |
$108.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.80
|
| Rate for Payer: GEHA Commercial |
$197.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.80
|
| Rate for Payer: Multiplan All |
$256.62
|
| Rate for Payer: OMNI Networks Commercial |
$197.40
|
| Rate for Payer: One Health Plan PPO/POS |
$253.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.90
|
| Rate for Payer: Three Rivers Provider Network All |
$211.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.26
|
| Rate for Payer: Zelis Auto |
$112.80
|
| Rate for Payer: Zelis Worker's Compensation |
$76.99
|
|
|
SHAVING SKIN LESION 1 T/A/L DIAM 0.5CM/<
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
6111300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$239.70
|
| Rate for Payer: First Health Commercial |
$253.80
|
| Rate for Payer: First Health Workers Compensation |
$108.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.80
|
| Rate for Payer: GEHA Commercial |
$225.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.80
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$256.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$197.40
|
| Rate for Payer: One Health Plan PPO/POS |
$253.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$211.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$112.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$76.99
|
|
|
SHAVING SKIN LESION 1 T/A/L DIAM 0.5CM/<
|
Facility
|
OP
|
$266.82
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
7211300
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$160.09
|
| Rate for Payer: Cash Price |
$160.09
|
| Rate for Payer: Cigna Commercial |
$226.80
|
| Rate for Payer: First Health Commercial |
$240.14
|
| Rate for Payer: First Health Workers Compensation |
$103.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.14
|
| Rate for Payer: GEHA Commercial |
$213.46
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.14
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$242.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$186.77
|
| Rate for Payer: One Health Plan PPO/POS |
$240.14
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$200.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$106.73
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$72.84
|
|
|
SHAVING SKIN LESION 1 T/A/L DIAM 0.5CM/<
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
9400001
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$239.70
|
| Rate for Payer: First Health Commercial |
$253.80
|
| Rate for Payer: First Health Workers Compensation |
$108.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.80
|
| Rate for Payer: GEHA Commercial |
$225.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.80
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$256.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$197.40
|
| Rate for Payer: One Health Plan PPO/POS |
$253.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$211.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$112.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$76.99
|
|
|
SHAVING SKIN LESION 1 T/A/L DIAM 0.5CM/<
|
Facility
|
IP
|
$266.82
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
7211300
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$253.48 |
| Rate for Payer: Cash Price |
$160.09
|
| Rate for Payer: Cigna Commercial |
$226.80
|
| Rate for Payer: First Health Commercial |
$240.14
|
| Rate for Payer: First Health Workers Compensation |
$103.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.14
|
| Rate for Payer: GEHA Commercial |
$186.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.14
|
| Rate for Payer: Multiplan All |
$242.81
|
| Rate for Payer: OMNI Networks Commercial |
$186.77
|
| Rate for Payer: One Health Plan PPO/POS |
$240.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.48
|
| Rate for Payer: Three Rivers Provider Network All |
$200.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.14
|
| Rate for Payer: Zelis Auto |
$106.73
|
| Rate for Payer: Zelis Worker's Compensation |
$72.84
|
|
|
SHEATH URETERAL FLEXOR
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
90008151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$71.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$165.00
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$242.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$137.50
|
|
|
SHEATH URETERAL FLEXOR
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
90008151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
|
|
sheep sorrell IgE REF602542
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
sheep sorrell IgE REF602542
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
